Thanks for that insight.  I've met a couple of transgendered people who quite clearly did the right thing for themselves and are far happier and more comfortable in the correct gender.

I've also met a couple of people who are seriously messed up and I couldn't tell if that was the result of the mental trauma of having lived in the wrong gender all of their lives or whether they just were fucked up and thought that a gender reassignment would sort all of their problems out - like running away and getting a new identity in some fantasy world where everything is perfect.  

The point you make about people lying to themselves fits with that, because that form of manipulation is so hard to see through, especially if you can't take the time to unravel what is really going on in a person's head.